=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144762360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUYAHOGA COMMUNITY COLLEGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2016
-----------------------------------------------------
Last Update Date | 11/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26242 DENNISPORT DR
-----------------------------------------------------
City | OAKWOOD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-5948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-571-9943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26242 DENNISPORT DR
-----------------------------------------------------
City | OAKWOOD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-5948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-571-9943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. RHONDA A HOOKS
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 216-571-9943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------